polio eradication

Guidelines For Clinicians In Polio

Eradication By

Dr. MAHASEN IBRAHIMASSISSTENT PROFESSION FOR PUBLIC

HEALTH

♦ Inspired by the success of global smallpox eradication and poliomyelitis control in the Americas, the World Health Assembly made a commitment in 1988 to eradicate polio by 2000.

Strategies for eradication:

high infant immunization coverage with four doses of oral poliovirus vaccine (OPV) in the first year of life & high quality SIA.

surveillance for wild poliovirus through reporting all acute flaccid paralysis (AFP) cases among children under fifteen years of age, with laboratory testing of two stool samples from at least 80% of cases.

1 -Efforts done to rise vaccination coverage and reach children in remote areas

Surveillance For Wild Poliovirus Through:

1. reporting all cases with acute flaccid paralysis in children up to 15 years of age, or any age when polio is suspected.

NB:reporting to the preventive health doctor must be within 24 hours of case detection.

surveillance for wild poliovirus through:

2. and laboratory testing of two stool samples

(samples to be collected within the first 14 days of paralysis onset , 24 hours apart and the first sample must be collected within 48 hours of case detection)

since The Global Polio Eradication Initiative launch in 1988, over 2 billion children have been immunized and a 99 percent reduction in polio has been achieved.

Polio endemic and importation countries in 2010

Certification is conducted on a regional basis. Each region can consider certification only when all countries in the region demonstrate the absence of wild poliovirus transmission for at least three consecutive years.

In polio-free regions:

What is required to achieve global certification ?

1. Maintain certification-standard surveillance for acute flaccid paralysis.

What is certification standard surveillance ?

the ability to detect annually at least 2 cases of non-polio acute flaccid paralysis (AFP) for every 100 000 children under 15 years of age.

two stool specimens (collected within the first 14 days of paralysis onset) must be collected from at least 80% of cases of acute flaccid paralysis and all specimens should be processed at a WHO accredited laboratory.

2. Ensure highest possible immunity levels against wild poliovirus (maintenance of high vaccination coverage).

3. Develop action plans for responding rapidly to importations of wild poliovirus.

•Any child under the age of fifteen years presenting with acute flaccid paralysis (including cases diagnosed as Guillian Barre Syndrome ) or any person of any age with paralytic illness if poliomyelitis is suspected .

Role Of Physicians In AFP Surveillance System

Notify immediately ( by phone within 24 hours ) to the preventive health sector any case presented with rapidly progressing weakness or flaccid paralysis including GBS in a child aging up to 15 years of age

Notify preventive health doctor

Two stool samples with at least 24 hours in between must be collected from the case within the first 14 days of paralysis onset = adequate samples.

2 stool samples in first 14 days

It must be : within 48 hours of case detection INCLUDE: clinical, neurological (with NCS EMG) and

virological investigation ( including stool samples for virologic study)

Why it is important to immediately investigate the reported case?

1. Polio is a public health emergency---a highly communicable disease.

2. Do not want to “lose the case”.3. Must start stool collection process.

Weekly zero report

If you didn't see any case in a week please fulfill the weekly zero report for poliomyelitis and AFP cases by writing zero in each cell.

Neurological assessment of the case with EMG & NCS

EMG & NCS

do follow up examination to assess the presence of paralysis after 60 days of onset.

Follow up at 60 days

Fulfill data of national case documentation forms.

Case documentations

YOUTHANK